Provider Demographics
NPI:1972723211
Name:MORRISON, CHARLES B (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:MORRISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26437 HWY 42
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:LA
Mailing Address - Zip Code:70744-6412
Mailing Address - Country:US
Mailing Address - Phone:985-981-0018
Mailing Address - Fax:
Practice Address - Street 1:32106 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462
Practice Address - Country:US
Practice Address - Phone:225-294-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1827380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1827380Medicaid